No Mortality Benefit From Primary Androgen-Deprivation Therapy for Most Men With Early-Stage Prostate Cancer
A large retrospective cohort study by Potosky et al of 15,170 men with early-stage prostate cancer has found that patients who received androgen deprivation as their primary treatment instead of surgery or radiation did not live any longer than those who received no curative-intent treatment. Men with higher-risk disease may derive a modest clinical benefit from the therapy. The study is published in the Journal of Clinical Oncology.
According to the researchers, accurate data comparing the mortality risk for primary androgen-deprivation therapy vs no therapy among men with clinically localized prostate cancer are needed. “Although there is no evidence that primary [androgen-deprivaion therapy] improves survival rates, at least 40% of men older than 65 years who have clinically localized prostate cancer that was initially managed without surgery or radiation received [primary androgen-deprivation] monotherapy between 1998 and 2002,” they reported. By the early 2000s, the therapy was the second most common treatment after radiotherapy for clinically localized prostate cancer among older men.
Study Details
The researchers conducted a retrospective cohort study using cancer registries linked with extensive electronic medical records in three, large integrated health plans. All 15,170 men included in the study were newly diagnosed with clinically localized prostate cancer between 1995 and 2008 and received follow-up through 2010. They did not have surgery or radiation therapy.
The study found that overall, primary androgen-deprivation therapy was associated with neither a risk of all-cause mortality (hazard ratio [HR] = 1.04; 95% confidence interval [CI] = 0.97–1.11) nor prostate cancer–specific mortality (HR = 1.03; 95% CI = 0.89–1.19) after adjusting for all sociodemographic and clinical characteristics. While the treatment was associated with decreased risk of all-cause mortality, it was not associated with prostate cancer–specific mortality. Primary androgen-deprivation therapy was associated with decreased risk of all-cause mortality only among the subgroup of men with a high risk of cancer progression (HR = 0.88; 95% CI = 0.78–0.97).
The study did not compare androgen-deprivation therapy directly to either surgery or radiation therapy, the two main curative treatment options for prostate cancer.
“Our main conclusion is that [primary androgen-deprivation therapy] does not seem to be an effective strategy as an alternative to no therapy among men diagnosed with clinically localized [prostate cancer] who are not receiving curative-intent therapy. The risks of serious adverse events and the high costs associated with its use mitigate against any clinical or policy rationale for [primary androgen-deprivation therapy] use in these men,” wrote the authors.
The researchers are now planning on using their database of 15,170 patients to investigate rates of potential side effects from primary androgen-deprivation therapy.
Arnold L. Potosky, PhD, of Georgetown University Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by grants from the National Cancer Institute. The study authors reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
